Sir.—I read with interest the timely article by Lindsley1 published in the February 1993 issue of AJDC on nonsteroidal anti-inflammatory drugs (NSAIDs) in children. I am, however, concerned by the author's statement that NSAIDs can be given in combination with corticosteroids to pediatric patients with rheumatic diseases. Gastrointestinal damage, including ulcers of the stomach and duodenum, has been noted significantly more frequently in adult users of NSAIDs than in nonusers.2 This may be less common in children. However, adults who use both NSAIDs and corticosteroids have an even greater risk (4.4) of developing peptic ulcer disease.3 The latter study found that concurrent use of corticosteroids and NSAIDs led to a "risk for peptic ulcer disease that was 15 times greater than that of nonusers of either drug."3
Based on the aforementioned data in adults, I think that it is prudent to recommend that NSAIDs not
BARTON LL. Nonsteroidal Anti-inflammatory Drugs and Gastrointestinal Injury in Children. Am J Dis Child. 1993;147(12):1280. doi:10.1001/archpedi.1993.02160360022006
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